Tuberculosis (TB) - Program Overview

The Tuberculosis Program (TB Program) oversees, manages, and facilitates the various activities and interventions necessary to assure identification and proper treatment of all individuals with tuberculosis to eliminate its subsequent spread to others.

The TB Program provides medication and educational services to prevent and control infection and disease caused by Mycobacterium tuberculosis. Department of Health Services staff from the Division of Public Health based in Madison are responsible for disease surveillance, monitoring of statistical trends, and individual case management consultation to local health departments. Staff also conduct tuberculosis prevention and control consultation and training to health care providers statewide.

Medication Needs

The TB Program manages an anti-tuberculosis therapy program in accordance with Wisconsin Statute 252.07. Persons with tuberculosis infection, suspect or confirmed tuberculosis disease, or household contacts with infectious tuberculosis may receive anti-tuberculosis medication free of charge through their local health department. A physician may request medication by completing the appropriate form and submitting it to the patient's local health department.

In addition to ensuring medication needs are met, the Wisconsin Tuberculosis Program also has a TB Dispensary Program that uses state tax revenue funds to reimburse local health departments for medical management of TB cases, suspects, contacts, and latent TB infection. The primary purpose of the tuberculosis dispensary is to ensure that all persons in Wisconsin with suspected or confirmed tuberculosis infection or disease can receive appropriate evaluation, treatment, and monitoring, regardless of insurance availability. Dispensary funds are to ensure that directly observed therapy (DOT) is provided for all persons with TB disease, and directly-observed preventive therapy (DOPT) is provided for persons at high risk of moving from infection to disease.

The dispensary must be the LAST payer after all other potential sources have been billed. The payer order is:

Private insurance

Public insurance: Medicare, Medicaid (MA), and TB-only Medicaid

TB dispensary

Local health departments or combinations of two or more health departments who are “in good standing,” as determined by their overall health department review process, may request certification as a dispensary for TB clinical services. As a dispensary, an LHD must ensure that all services provided, or arranged for, are consistent with CDC and Wisconsin TB Program guidelines and clinical standards of practice for TB control and elimination, and that these services are provided in keeping with goals for the elimination of TB in Wisconsin.

The Wisconsin Tuberculosis Program will provide consultation, guidance, and review of the local health department TB programs, policies, procedures, and clinical practices to ensure that they are in compliance with Wisconsin statutes, administrative codes and established standards of practice, particularly those outlined in State Statute 252.10.

Once it is determined that an LHD can meet established requirements for TB care, the actual steps to becoming a certified dispensary include agreeing on a budget, developing a Clinical Services Plan (CSP), and signing an annual contract. The contract essentially establishes a line of credit with the TB Program, which enables the LHD to bill for covered TB clinical services. TB clinical services are specific and limited by Wisconsin Administrative Code 9 [DHS 145.12 (1)].

As determined by Wisconsin Administrative Code, services are reimbursed at the MA rate, however, the TB Dispensary Program is not an MA program. Services are more limited in scope than Medicaid TB Case Management.

While Wisconsin has a low incidence of TB, under 1 person in 100,000, the medical services cost to manage a case can reach over $3,000 per case with treatment over an extended period of time. A drug-resistant case can cost over $700,000. All local health departments are strongly encouraged to become a Certified TB Dispensary.

To learn more about the Dispensary Program, contact Norma Denbrook, Public Health Educator at 608-261-6388.